Staging Paradox and recurrence pattern among stage IIB, IIC, and IIIA Colon cancers: a retrospective cohort study.

IF 2.5 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY International Journal of Colorectal Disease Pub Date : 2024-10-14 DOI:10.1007/s00384-024-04737-1
Yu-Tso Liao, John Huang, Ji-Shiang Hung, Kai-Wen Huang, Jin-Tung Liang
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Abstract

Purpose: The survival rates of patients with stage IIB and IIC colon cancer are paradoxically inferior to that of patients with stage IIIA colon cancer. This study aimed to examine the oncological outcomes and investigate the factors that could affect the staging paradox among stage IIB, IIC, and IIIA colon cancers based on a 9-year cancer database.

Methods: Patients with stage IIB (pT4aN0M0), IIC (pT4bN0M0), or IIIA (pT1-2N1M0) colon cancer were retrospectively selected from a prospectively maintained medical database from January 2011 to December 2019. Factors that might influence the staging paradox, including radicality, harvested lymph nodes, and chemotherapy administration, were examined.

Results: A total of 282 patients (stage IIB, n = 59; stage IIC, n = 46; and stage IIIA, n = 177) were enrolled. Patients with stage IIB/C cancer demonstrated higher carcinoembryonic antigen levels, larger tumor size, more frequent tumor obstruction, and higher locoregional recurrence than those with stage IIIA cancer. With respect to 10-year locoregional recurrence-free survival and cancer-specific survival, patients with stage IIB and IIC cancers had significantly lower survival rates than did those with stage IIIA cancer (73.7% vs. 66.3% vs. 91.2%, P = 0.0003; 5.4% vs. 10.9% vs. 11.2%, P = 0.0023). The staging paradox persisted in patients who underwent R0 resection, had harvested lymph nodes ≥ 12, and received chemotherapy, as confirmed by multivariate regression analysis.

Conclusions: Based on the inferior oncological outcomes and higher locoregional recurrence rate, this study highlighted the need for intensified cytotoxic chemotherapy specific to this recurrence pattern for patients with stage IIB/C colon cancer.

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IIB、IIC 和 IIIA 期结肠癌的分期悖论和复发模式:一项回顾性队列研究。
目的:IIB期和IIC期结肠癌患者的生存率低于IIIA期结肠癌患者,这是一个矛盾。本研究旨在基于一个为期 9 年的癌症数据库,研究 IIB、IIC 和 IIIA 期结肠癌的肿瘤学结果,并调查可能影响分期悖论的因素:从2011年1月至2019年12月前瞻性维护的医疗数据库中回顾性选取IIB期(pT4aN0M0)、IIC期(pT4bN0M0)或IIIA期(pT1-2N1M0)结肠癌患者。研究考察了可能影响分期悖论的因素,包括根治率、收获的淋巴结和化疗用药:共纳入 282 例患者(IIB 期,59 例;IIC 期,46 例;IIIA 期,177 例)。与IIIA期癌症患者相比,IIB/C期癌症患者的癌胚抗原水平更高、肿瘤体积更大、肿瘤梗阻更频繁、局部复发率更高。在10年无局部复发生存率和癌症特异性生存率方面,IIB期和IIC期癌症患者的生存率明显低于IIIA期癌症患者(73.7% vs. 66.3% vs. 91.2%,P = 0.0003;5.4% vs. 10.9% vs. 11.2%,P = 0.0023)。多变量回归分析证实,在接受R0切除术、摘除淋巴结≥12个并接受化疗的患者中,分期悖论依然存在:基于较差的肿瘤治疗效果和较高的局部复发率,该研究强调了针对 IIB/C 期结肠癌患者的这种复发模式加强细胞毒性化疗的必要性。
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来源期刊
CiteScore
4.90
自引率
3.60%
发文量
206
审稿时长
3-8 weeks
期刊介绍: The International Journal of Colorectal Disease, Clinical and Molecular Gastroenterology and Surgery aims to publish novel and state-of-the-art papers which deal with the physiology and pathophysiology of diseases involving the entire gastrointestinal tract. In addition to original research articles, the following categories will be included: reviews (usually commissioned but may also be submitted), case reports, letters to the editor, and protocols on clinical studies. The journal offers its readers an interdisciplinary forum for clinical science and molecular research related to gastrointestinal disease.
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